Module 4 - Identify and Refer: Emergent vs Urgent

Handle all body fluids and blood as it is infected

True

Sideline PPE

• disposable gloves

• CPR mask (one way valve)

An athlete’s health and safety is the top priority

False, you should always ensure yourself is safe before helping others

Mechanism of Injury

• Understanding the force and direction applied can aid in hypothesizing a potential injury and structures affected

• how the injury occurred

• what potential forces may be involved

Match planes of motion with their axis of rotation

• Sagittal plane - Mediolateral axis

• Frontal plane - Anteroposterior axis

• Transverse plane - Longitudinal axis

Movement occurring in mediolateral axis

flexion and extension

Movement occurring in frontal plane

abduction and adduction

Movement occurring in longitudinal axis

internal and external rotation

Varus position of knee

• knees pointing laterally

• bowlegs

Valgus position of knee

• knees creeping inwards

• knock-knees

Sign

• observable finding that you see

• can see, hear, smell

• ex. swelling, bruising

Symptom

• information provided by patient about their problem

• ex. pain, grinding, dizziness

Primary Survey

• LOC - level of consciousness

• ABCDs - airway, breathing, circulation, deadly bleeding

• Make decision - EAP vs secondary survey

• Triage

Triage

the ability to rapidly assess all injured patients and provide immediate treatment to the most seriously injured

Emergent

• injuries/conditions that will impair/has potential to impair CNS or cardiovascular system (life or death)

• activate EAP immediately

• determined in primary survey

Examples of an emergent situation

• no airway

• not breathing

• no pulse

• deadly bleeding

• head/spinal injury

Urgent

• severe/major injury

• likely needing further medical management

• determined in secondary survey

Examples of an urgent situation

• shock

• concussion

• bleeding

• fractures

• serious eye injury

• unwilling to support body weight or unwilling to move

• further damage may result if moved

Minor injury

• likely needs an x-ray

• doesn’t need ER/OR

Other injuries (not emergent, urgent, or minor)

can another healthcare professional address concerns likely tomorrow

AVPU

way to determine LOR

• Alert (x4)

• Verbal

• Painful

• Unconscious

Inspection for head trauma

• pupils normal or dilated

• redness, bruising, or discolouration in facial area/behind ears

• clear fluid/bloody discharge from ears or nose

Inspection of injured body part

check for joint alignment, redness, swelling, bruising, cuts

Red flags that would require activation of EAP

• unconscious

• loss of consciousness in presence of head trauma

• respiratory distress. failure, or airway obstruction

• no pulse

• severe chest/abdominal pain

• deadly bleeding

• severe heat illness

• severe shock

• suspected spinal injury

• fractures inviting several ribs, femur, pelvis

• sevrer hypoglycaemia

• collapse in response to sickling episode

• extreme ranges deviating from normal BP, pulse, respiration rate

Respiratory arrest

the inability to breathe independently

Any individual found unconscious should be treated for head and neck injury, to protect the spine

True

How would you open the airway with someone suspected of head/spinal injury

jaw thrust

Cardiac arrest

• heart has stopped beating or blood loss is too great for the heart to pump

• no breathing and no pulse

• may be blue in colour and have dilated pupils

Shock

• A serious complication of an injury leading to inadequate blood to vital tissues such as the brain and organs

• If lead unmanaged can lead to death

Severity of shock

Depends on age, physical condition, pain tolerance, fatigue, dehydration, presence of disease, extreme cold, extreme heat, or handling of injured area

Types of shock

• anaphylactic

• cardiogenic

• metabolic

• neurogenic

• respiratory

• psychogenic

• septic

S+S of shock

• restlessness, anxiety, fear, irritable

• weak and rapid pulse

• shallow and rapid breathing

• dilated pupils

• blue/grey pallor (lips, tongue, nail beds)

• pale, cool, and clammy skin

• profuse sweating

• nausea

• thirst

Possible cause and effects of hypovolemic shock

• Hemorrhage, severe vomiting, diarrhea, dehydration and/or burns

• Loss of body fluid resulting in decreased circulating blood volume

Possible cause and effects of respiratory shock

• Spinal Injury affecting respiratory nerves, airway obstruction, or chest trauma

• Decreased breathing efficiency resulting in insufficient oxygen in the blood

Possible cause and effects of neurogenic shock

• Spinal or head injury resulting in damaged nerves

• Peripheral blood vessels dilate, and a decreased blood volume cannot supply oxygen to vital organs

Possible cause and effects of psychogenic shock

• ’Freight shock’: physiological response to fear, stress, or emotional crisis

• ex. fainting from sight of blood

• Temporary dilation of blood vessels, resulting in blood being drained from the head and pooling in the abdomen

Possible cause and effects of cardiogenic shock

• Injury to the heart or heart attack

• Heart is unable to circulate and sustain pressure to pump blood to the cells

Possible cause and effects of metabolic shock

• Insulin shock, diabetic coma, vomiting, diarrhea

• Severe loss of body fluids because of untreated illness that alters the biochemical equilibrium

Possible cause and effects of septic shock

• From a severe, often bacterial infection

• Toxins attack the walls of blood vessels, causing them to dilate, and decreasing blood pressure

Possible cause and effects of anaphylactic shock

• Severe allergic reaction

• Difficulty breathing, burning, itching or hives, tingling or swelling to face or tongue

• Can result in decreased oxygen to vital organs

Management of shock

• activate EAP

• maintain airway

• control bleeding

• splint fractures

• maintain body temperature

• monitor vitals (every 2-5 minutes)

How to position someone in shock

elevate feet 8-12 inches

How to position someone with breathing difficulties

elevate head and shoulder in semi-reclined position

How to position someone with head injury

elevate neck and shoulders

How to position someone who is vomiting or unconscious

recovery position

What type of injuries would result in a rapid/weak pulse

• shock

• internal hemorrhage

• hypoglycemia

• heat exhaustion

• hyperventilation

What type of injuries would result in a rapid/bounding pulse

• heat stroke

• fright

• fever

• hypertension

• apprehension

• hyperglycemia

• normal exertion

What type of injuries would result in a slow/bounding pulse

• skull fracture

• stroke

• drug use

• cardiac problems

• some poisons

What type of injuries would result in no pulse

• blocked artery

• low BP

• cardiac arrest

Normal ranges for child and adult pulse

Child: 120-140 bpm

Adult: 60-100 bpm

Normal range for respiration rate (adult and child)

• Adult: 10-25 bpm

• Child: 20-25 bpm

What type of injuries would result in shallow breathing

• shock

• heat exhaustion

• insulin shock

• chest injury

• cardiac problems

What type of injuries would result in irregular breathing

• airway obstruction

• chest injury

• diabetic coma

• asthma

• cardiac problems

What type of injuries would result in rapid/deep breathing

• diabetic coma

• hyperventilation

• some lung diseases

What type of injuries would result in frothy blood

• lung damage

• ex. punctured from rib or penetrating object

What type of injuries would result in slowed breathing

• stroke

• head injury

• chest injury

• use of certain drugs

What type of injuries would result in no breathing

• cardiac arrest

• poisoning

• drug abuse

• drowning

• head injury

• intrathoracic injuries

What type of injuries would result in wheezing

asthma

What type of injuries would result in apnea

• hypoxia

• congestive heart failure

• head injuries

What type of injuries would result in crowing

spasms of larynx

What type of injuries would result in dry/cool skin

• exposure to cold

• spine injuries

What type of injuries would result in cool/clammy skin

• shock

• internal hemorrhage

• trauma

• anxiety

• heat exhaustion

What type of injuries would result in hot/dry skin

• disease

• infection

• high fever

• heat stroke

• overexposure to environmental heat

What type of injuries would result in hot/moist skin

• high fever

What type of injuries would result in an isolated hot spot

localized infection

What type of injuries would result in a cold appendage

• circulatory problem

What type of injuries would result in goose bumps

• chills

• communicable disease

• exposure to cold

• pain

• fear

What type of injuries would result in red skin

• fever

• hypertension

• heat stroke

• carbon monoxide poisoning

• diabetic coma

• alcohol abuse

• infectious disease

• inflammation

• allergy

What type of injuries would result in white/ashen skin

• anemia

• shock

• heart attack

• hypotension

• heat exhaustion

• insulin shock

• insufficient circulation

What type of injuries would result in blue/cyanotic skin

• heart failure

• some severe respiratory disorders

• some poisoning

What type of injuries would result in yellow skin

• liver disease

• jaundice

PEARL

Pupils

Equal

And (Active - tracking)

Reactive to

Light

What type of injuries would result in pinpoint pupils

• poisonings

• brainstem dysfunction

• opiate use

What type of injuries would result in dilated but reactive pupils

• in the dark

• post seizure

What type of injuries would result in dilated and fixed pupils

• brainstem herniation

• increased cranial pressure

What type of injuries would result in one dilated and one fixed pupil

• ipsilateral uncal herniation

• epidural hematoma

What type of injuries would result in CSF leakage from nose/ear

basilar bone fracture of temporal bone

What type of injuries would result in racoon eyes

• facial fracture

• basilar fracture

What type of injuries would result in battle signs

basilar fracture

HOPS

History - SAMPLE, OPQRST, chief complaint

Observations - analysis of appearance

Palpation - temp, tone, tenderness, crepitus, deformity, swelling, pulse

Special Tests - ROM, strength, joint stressing

What types of injuries would you refer to another professional (serious but not life threatening)

• eye injuries

• dental injuries

• minor/simple fracture

• lacerations that may require suturing

• injuries resulting in a functional deficit

• loss of sensation/absent reflexes

• evident weakness in extremities

• any injury you are uncertain about

Ambulatory assistance

athlete can walk but needs some assistance

Manual conveyance

athlete is unable to walk and/or is too far to walk

Transport by rigid immobilization

safest method - spinal motion restriction

What is the first thing that should be removed on the field when assessing injury

mouthguard

An athletes helmet should always be removed to better assess their injuries

False, never remove unless absolutely necessary

Should you remove shoulder pads to assess injury

No, unless life threatening injury or need to do CPR/AED

Should you remove a face mask to assess injury

Yes, increases airway access

Options for documenting

• injury form

• SOAP not

• HOPS note

SOAP note

Subjective (history)

Objective (observation, palpation, special tests)

Assessment (patient status and prognosis)

Plan (treatment given, referral needed, future goals)